Colon Cancer Surgery
Colon/Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the colon.
The colon is part of the body’s digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The digestive system is made up of the esophagus, stomach, and the small and large intestines. The first 6 feet of the large intestine are called the large bowel or colon. The last 6 inches are the rectum and the anal canal. The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
Stages of Colon/Rectal Cancer
After colon cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or to other parts of the body.
The process used to find out if cancer has spread within the colon or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
As colon cancer progresses from Stage 0 to Stage IV, the cancer cells grow through the layers of the colon wall and spread to lymph nodes and other organs.
Stage 0 (Carcinoma in Situ)
In stage 0, the cancer is found only in the innermost lining of the colon. Stage 0 cancer is also called carcinoma in situ.
Stage 1
In stage I, the cancer has spread beyond the innermost tissue layer of the colon wall to the middle layers. Stage I colon cancer is sometimes called Dukes’ A colon cancer.
Stage II
In stage II, the cancer has spread beyond the middle tissue layers of the colon wall, or has spread to nearby tissues around the colon or rectum, or has spread beyond the colon wall into nearby organs and/or through into the abdominal cavity. Stage II colon cancer is sometimes called Dukes’ B colon cancer.
Stage III
In stage III, the cancer has spread from the innermost tissue layer of the colon wall to the middle layers and has spread to as many as 3 lymph nodes. Stage III colon cancer is sometimes called Dukes’ C colon cancer.
Stage IV
In stage IV, cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs. Stage IV colon cancer is sometimes called Dukes’ D colon cancer.
Colon/Rectal Cancer Treatment Options
Laparoscopic Colon Surgery
Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer. Most of the time surgery can be performed laparoscopically (through small incisions).
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is administered, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Chemotherapy is generally given after surgery for stage III and above colon cancers.
Colon/Rectal Cancer Treatment by Stage
Stage 0 Colon/Rectal Cancer is generally removed during colonoscopy. If the tumor is too large cannot be removed during colonoscopy surgery may be required.
Stage I Colon/Rectal Cancer is generally treated by laparoscopic surgical removal of the cancer.
Stage II Colon Cancer is generally treated by laparoscopic surgical removal of the cancer. Stage II Rectal Cancer is generally treated by laparoscopic surgical removal of the cancer followed by chemotherapy.
Stage III Colon Cancer is generally treated by laparoscopic surgical removal of the cancer followed by chemotherapy. Stage II Rectal Cancer is generally treated by radiation therapy and chemotherapy initially, followed by laparoscopic surgical removal of the cancer, followed by more chemotherapy.
Stage IV Colon or Rectal Cancer treatment is highly variable but generally consists of a combination of surgery, chemotherapy, and radiation therapy
Laparoscopic Colon Resection
About Conventional Colon Surgery….
Each year, more than 600,000 surgical procedures are performed in the United States to treat a number of colon diseases. Although surgery is not always a cure, it is often the best way to stop the spread of disease and alleviate pain and discomfort.
Patients undergoing colon surgery often face a long and difficult recovery because the traditional “open” procedures are highly invasive. In most cases, surgeons are required to make a long incision. Surgery results in an average hospital stay of a week or more and usually 6 weeks of recovery.
What is Laparoscopic Colon Resection?
A technique known as minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.
In most laparoscopic colon resections, surgeons operate through 2 or 3 small openings (each about a quarter inch) while watching an enlarged image of the patient’s internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.
What are the advantages of Laparoscopic Colon Resection?
Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:
- Less postoperative pain
- May shorten hospital stay
- May result in a faster return to solid-food diet
- May result in a quicker return of bowel function
- Quicker return to normal activity
- Improved cosmetic results
How Is Laparoscopic Colon Resection Performed?
“Laparoscopic” surgery describes the techniques a surgeon uses to gain access to the internal surgery site.
Most laparoscopic colon procedures start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove part of the colon. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions.
What happens if the operation cannot be performed or completed by the Laparoscopic method?
In a number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include:
- Obesity
- A history of prior abdominal surgery causing dense scar tissue
- Inability to visualize organs
- Bleeding problems during the operation
- Large tumors
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
What should I expect after Surgery?
After the operation, it is important to follow your doctor’s instructions. Although many people feel better in a few days, remember that your body needs time to heal.
- You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
- You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
- Call and schedule a follow-up appointment within 2 weeks after your operation.
What Complications can occur?
These complications include:
- Bleeding
- Infection
- A leak where the colon was connected back together.
- Injury to adjacent organs such as the small intestine, ureter, or bladder
- Blood clots to the lungs.
It is important for you to recognize the early signs of possible complications.